Cancer Res Treat.  2013 Dec;45(4):270-275.

Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

• Hong JH
• Rho SY
• Hong YS

Abstract

PURPOSE
It is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients.
MATERIALS AND METHODS
We retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death.
RESULTS
During the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death.
CONCLUSION
Our results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives.

Keyword

End-of-life care; Aggressiveness; Palliative chemotherapy; Stomach neoplasms

MeSH Terms

Aspartate Aminotransferases
Bilirubin
Blood Platelets
C-Reactive Protein
Creatinine
Drug Therapy
Emergencies
Hospices
Humans
Intensive Care Units
Quality of Life
Referral and Consultation
Resuscitation Orders
Retrospective Studies
Stomach Neoplasms*
Stomach*
Terminally Ill
Aspartate Aminotransferases
Bilirubin
C-Reactive Protein
Creatinine

Figure

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  Fig. 1 Study diagram.

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  Fig. 2 Period between last chemotherapy day and death.

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  Fig. 3 Periods of significant changes in laboratory values. CRP, C-reactive protein; AST, aspartate aminotransferase.

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